Economic Barriers to Abortion Reduce Access to Care Even in States Where the Procedure is Legal

Only three states - New York, California, and Oregon - mandate public and private coverage for abortion care.Only three states – New York, California, and Oregon – mandate public and private coverage for abortion care.

By Isabel Carter

A. had resigned herself to becoming a parent, even though it wasn’t what she wanted. She had been trying to get an abortion since she discovered she was six weeks pregnant, but she couldn’t afford the cost of the procedure. That was 15 weeks ago, and the price had only gone up since then.

Too ashamed to reach out to her family or friends when she discovered her situation, A. had turned to the man who had gotten her pregnant for assistance. But despite initial promises to help, the man changed his tune and began pressuring her to carry the pregnancy to term. By the time she gave up hope in his cooperation, the cost of the procedure had ballooned to around $2,000, far more than she could hope to scrape together before the pregnancy passed beyond the 22-week timeframe for a legal abortion.

She was desperate by the time she connected with an abortion fund the next state over, but her desperation turned to hope when they promised her they would take care of the fees. And they kept their promise. With their aid, A. was finally able to receive an abortion at 21 weeks.

Buzzfeed News reported the story of this young woman—who requested to be identified only as “A.—in June after her home state of Arkansas passed a bill to ban abortion after 18 weeks. The law, which was slated to go into effect on July 24, has already been challenged in court.

Though it may be surprising, her experience is not uncommon; abortion seekers across the country regularly find themselves stuck between insurmountable expenses and the ticking clock of legal abortion timelines. In fact, only California, Oregon, and New York currently require public and private health insurance providers to cover all or most abortions. And even then, uninsured residents are forced to fend for themselves when confronted with an unwanted pregnancy. A.’s story is just one example of the barriers to abortion access that go beyond the already fraught question of legality.

“Roe v. Wade has never been a promise of abortion access for far too many people who don’t have the right insurance or don’t make enough money or live in areas where there is no abortion clinic or abortion provider,” said Yamani Hernandez, Executive Director of the National Network of Abortion Funds.

As state after state has passed rollbacks on the legality of abortion, Hernandez pointed out that this is the way that access to the procedure has already looked for many Americans.According to her, 29% of abortion seekers were already without access before any of these bills went into effect.

”Abortion is something you can’t delay. You’ve got to do it right away, and a lot of people are economically marginal and don’t have the resources to come up with the funds right away,” said Carrie Baker, president of the Abortion Rights Fund of Western Massachusetts. She says there are many gaps in coverage—even in a progressive state like Massachusetts.

”Some of the gaps are like, you’re undocumented and you don’t have insurance,” she said. “Another gap is that you’re a young person and you don’t want to tell your parents” and therefore can’t use their insurance to pay for the procedure. Baker pointed out that even with insurance and the autonomy to use it, high deductibles can put an abortion seeker right back at square one.

Lawmakers in Massachusetts are currently considering a bill that would require all health insurance providers to cover abortion in their plans, but for now Baker’s organization is one of three in the state that people can turn to for help making ends meet when trying to access abortion care. In 2018, Baker’s fund gave away over $85,000. She said even that wasn’t enough to cover all the demand: “we can’t meet them all. We definitely don’t meet them all unfortunately.”

That’s partially because of the number of callers they get; it’s also due to the hidden costs of abortion that the funds also cover to make the procedure accessible. According to Mae Fuchs, board president of the Eastern Massachusetts Abortion Fund, these include travel and transportation fees, the cost of taking time off work and, often, childcare.

“Parents get abortions more than anyone,” said Fuchs.

Another big expense for abortion funds are cases in which pregnant people have to travel out of state for “later care,” or abortions after the state’s deadline of 23 weeks. At that stage in the pregnancy, the cost of the procedure is at least $10,000 and can even go up to sums as high as $17,000. Though later care is rare and often occurs in cases of a “fatal fetal anomaly” that would make it impossible for the fetus to survive outside of the uterus, Victoria Angelico, who sits on the board of the Jane Fund in central Massachusetts, stressed that Jane does not ask callers to divulge personal information about why they are seeking an abortion.

”They can’t afford it,” she said. “They are disabled. They are in a spot where they have a difficult partnership or non-partnership situation. Basically they just cannot. They can’t. And that’s enough.”

All four fund leaders cited these economic barriers to abortion access as reasons why they have begun to shift away from a framework that focuses narrowly on reproductive rights to ones that take more wholistic look at reproductive justice.

“The reproductive justice framework doesn’t just focus on abortion,” said Baker. “It focuses on not only the right not to have a child but the right to have a child and raise them in a safe and healthy environment, so it’s much more comprehensive.”

The term “reproductive justice” was coined in 1994 by Loretta Ross of SisterSong and the eleven other Black women who formed the Women of African Descent for Reproductive Justice alliance.

“We placed ourselves in the center of our analysis and made the case that while abortion was a crucial resource for us, we also needed health care, education, jobs, day care, and the right to motherhood,” Ross writes in a new book she co-authored called Reproductive Justice: An Introduction.

According to Baker, women of color and poor women are disproportionately represented among abortion seekers, and they are also the ones least able to access it.

”Those dynamics don’t get talked about very much,” she said. “But this is all about race. It’s all about race and gender. It’s about keeping women under control and keeping people of color under control.”

But she and Fuchs and the rest of the fund leaders have a different plan. On EMA’s website the fund lists their guiding values. Number two reads, “We work to build a world where the EMA Fund will no longer be needed to ensure access to abortions.”

Fuchs explained: “We dream of the day when abortion access is legal for all and is completely covered by whatever insurance so that the procedures are without cost, and the world is so economically just that eveyone can afford all of their travel and housing. We dream of a world where nobody needs financial help from anybody to be comfortable and still get their procedure. We dream of a world where we can get a vacation. And until that world exists, we’ll keep fighting”